Provider Demographics
NPI:1326443037
Name:MCCLEAN, JANE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MCCLEAN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CHESAPEAKE PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4201
Mailing Address - Country:US
Mailing Address - Phone:410-682-2726
Mailing Address - Fax:
Practice Address - Street 1:103 CHESAPEAKE PARK PLZ
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-4201
Practice Address - Country:US
Practice Address - Phone:410-682-2726
Practice Address - Fax:410-682-2538
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00006242255A2300X
NC21682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer